The Disscussion Of Vascular Endothelial Growth Factor And Transforming Growth Factor-β1 In The Pathogenesis Of Tuberculous Meningitis

Objective: Tuberculous meningitis (TBM) is caused by Mycobacterium tuberculosis,the bacterial invasive subarachnoid and create inflammatory changes involving the leptomeningeal. In addition,the arachnoid,brain parenchyma and cerebral blood vessels are often involved. It is the most serious extrapulmonary tuberculosis.The occurrence,development and fate of tuberculosis are not only depend on the amount and virulence of the bacterial,but also depend on the immune function. In intracranial infection, inflammatory cells or platelet can generate vascular endothelial growth factor (VEGF), which break blood-brain barrier and cause cerebral edema. Transforming growth factor-β1 (TGF-β1) is a cytokine, that can inhibit the function of T cell, monocyte-macrophage cells, it may be involved in the immune pathogenesis of tuberculosis as a central role. In this study, by measuring the levels of vascular endothelial growth factor and Transforming growth factor-β1 in cerebrospinal fluid and observing the dynamic content,in order to explore the pathogenesis of tuberculous meningitis and provide the basis for immunotherapy and anti-inflammatory treatment in the future.Methods: All these patients were from the Second Hospital of Hebei Medical University during the period of 2008 March~2009 August.1 tuberculous meningitis: 26 cases are diagnosed as tuberculous meningitis, including 13 of highly probable tuberculous meningitis,6 of probable tuberculous meningitis and 7 of possible tuberculous meningitis.2 The control group: 1 patient with spinal muscular atrophy,1 patient with neurosis,1 patient with Organophosphate poisoning,2 patients with arachnoiditis of spinal cord,1 patient with renal abscess,4 patients with demyelinating disease,1 patient with peripheral neuropathy,1 patient with multiple system atrophy,1 patient with cavernous sinus syndrome,13 cases of outpatients are excluded central nervous system infection by lumbar puncture.CSF was collected by lumbar puncture in all patients and were analyzed routine,biochemical and cytology (MGG dye and aricine blue staining). Apply the ABC-ELISA method to measure the level of TGF-β1 and VEGF.Results:1 CSF biochemical test:Compare the protein levels in cerebrospinal fluid in tuberculous meningitis (1.47±0.57g/L) and control group(0.35±0.22g /L),there was a statistical significance. Compare the glucose levels in cerebrospinal fluid in tuberculous meningitis (2.07±0.99mmol/L)and control group(3.86±1.19mmol/L),there was a statistical significance. Compare the chloride levels in cerebrospinal fluid in tuberculous meningitis (110.52±8.96 mmol/L) and control group(125.97±6.24mmol/L),there was a statistical significance.2 The levels of vascular endothelial growth factor in CSF:Compare the vascular endothelial growth factor levels in cerebrospinal fluid in tuberculous meningitis (15.625～347.457) pg/ml and control group(15.625～35.799) pg/ ml,there was a statistical significance. Compare the vascular endothelial growth factor levels in cerebrospinal fluid in highly probable tuberculous meningitis (18.136～347.457) pg/ml and probable combine with possible tuberculous meningitis (15.625～45.491) pg/ ml,there was a statistical significance. Compare the vascular endothelial growth factor levels in cerebrospinal fluid in 10 cases before treatment (15.625～182.407) pg/ml and after treatment (15.625～22.600) pg/ml,there was a statistical significance. It didn't have significant difference in levelⅠ,ⅡandⅢcases. Compare the vascular endothelial growth factor levels in cerebrospinal fluid in neutrophil cell dominant response and in lymphoid cells dominant response, there was not a statistical significance.3 The levels of Transforming growth factor-β1 in CSF:Compare the Transforming growth factor-β1 levels in cerebrospinal fluid in tuberculous meningitis (40.77±8.71pg/ml) and control group(37.69±5.05pg/ml), it didn't have significant difference.Conclusions:1 The level of VEGF in cerebrospinal fluid is rised in tuberculous meningitis. Detection of VEGF protein can support the diagnosis of tuberculous meningitis.Through dynamic observing the changes has the significance of disease monitoring in patients with tuberculous meningitis.2 The level of TGF-β1 in cerebrospinal fluid is higher in tuberculous meningitis than control group,but it didn't have significant difference. The role of TGF-β1 in the pathogenesis of tuberculous meningitis should be further researched.